Quality Control

There are many reasons why quality control is maintained for x-ray equipment. Some
being that certain organizations, such as the Joint Commission, require that it is done to ensure
that patient safety and image quality is continually fulfilled. Quality assurance takes care of the
patient, allowing that patients rights to safe exams are exercised. It is essential that the dose is
recorded correctly as well as how the tube makes the exposure, how the reader accepts the
incoming data and how it is displayed on the monitor. Every portion of the process needs to be
within range to trust that equipment is working properly and that patients safety is of utmost
concern. If errors occur without having been caught on quality control a patients dose may
increase due to double exposures, or over exposures as well as external physical safety concerns
with malfunctions of equipment causing any damage. Any time quality control is to be
performed it must be logged with dates and times as well as who performed the tests, what
equipment was tested and what test was being done. Hospital budget is also a factor in
maintaining quality control, ensuring that preventative maintenance tests are done accurately and
when needed allows any small fixes to be done early avoiding an avoidable costly repair if it
escalates. Integrity must be maintained that each test was done accurately and competently for
the sake of everyone involved.

For this reason designated people are responsible for carrying out the tests, a trained
technologist and a physicist are responsible for quality control. Each technologist should be
familiar with the signs of a possible problem with the equipment so service can be called as soon
as needed; however, to carry out the specific tests to the machinery only technologists that can
precisely and accurately maintain quality control are used. The physicist is responsible for
recalibrating baseline values and using the ion calibrator to check the accuracy of the exposure
indicator. They are also responsible for ensuring that all past quality control test have been
tracked, are up to date and have been recorded. They are required to do QC testing annually and
semi-annually for collimation testing.

Some tests and parameters for those tests are filtration, collimation and central ray
alignment, focal spot size, kVp and mA calibration, AEC and timer testing, exposure linearity
and reproducibility, protective apparel and luminescence are also tested. Filtration tests are done
annually and must be a minimum of 2.5mm/Al equivalent. It is measured by examining the halve
value layer. Collimation and central ray testing is done twice a year and ensures that the
collimated light field is displayed properly on the receptor. The central ray must be aligned
within 1% of SID and the collimated light field must be within 2% of light field. The focal spot
test can be done using a number of tools, including, the pinhole camera, the star pattern tool
(large focal spots), the slit camera (small focal spots) and the line-pair test tool. This test
determines spatial resolution and must have a variance of no more than 50%, one of these tests
must be done annually.
 KVp and exposure timer testing is also done annually, it is measured with a filtered ion
chamber or a filtered photodiode. Exposure timer testing can also be tested with a spinning top
test if a single phase generator is being tested. KVp must measure within 10% of selected kVP
while exposure time must be within 5% for exposures greater than 10ms and 10% for exposures
less than 10ms. AEC are also put under quality control testing, they must be tested to perform
with varying thicknesses of anatomy, this is done using a phantom, the backup timer is also
tested to ensure that the regulation is in place, making sure that it shuts off after either 6 seconds
or 600 mAs. Exposure linearity is tested annually and is done with the same cassette to ensure
that the radiation output is the same for every exposure, it is measured with a dosimeter and the
mR/mAs must be within 10%. Exposure is also tested by making sure that the same image is
reproduced when the same technique is used, this is exposure reproducibility testing and is
measured using a dosimeter or ion chamber as well. It must be within 5%. Luminescence is
measured using a photometer and any protective lead material is put under fluoro to check for
any defects.

Technologist responsibilities are much more often, from daily, weekly to monthly. Daily
they are to check the cassettes to make sure that they are in proper working order, that none of
them are having trouble latching or running in the cassette reader, they should erase them all and
check the laser reader for any defects as well, images are examined for artifacts and
sensitometers are used, as well as ensuring that images are being sent to PACS correctly. Weekly
they should clean the air intakes of the readers and clean the monitors and all computer
equipment that is used regularly as well as check for any exposure to wires, image acquisition
testing and cassette integrity testing, analyzing how often repeat images are taken and
determining exposure trends. Monthly the technologist should clean the imaging plates, check
for artifacts, and review repeat examinations to implement any coaching to other technologists.

SMPTE (Society of Motion Picture and Television Engineers) tests are done daily. The
SMPTE test, tests the four corners of an image, as well as contrast resolution. Different patterns
test different things as well, such as a TG18QC tests distortion and luminance. Preventative
maintenance for the machinery is also done by service personnel that know how to use, and fix
the equipment if needed. They carry out image display testing, screen erasure and spatial
frequency response testing using a phantom that measures line pairs and per mm at least 10mm
in length.

All of these components make up a strong quality control team that ensures that each
exposure made is safe for the patient and the technologists, that each exposure is putting out the
correct dose with accuracy, and that each image is accurate and correctly visible for reading.